Do you have questions about Kegel exercises after childbirth? You are not alone. Most women have heard they should be doing “Kegel” exercises to strengthen their pelvic floor muscles, especially after having a baby in order to reduce urinary leakage and pelvic organ prolapse risks. However, more often than not, the instructions given by the OB/GYN or childbirth educators are too vague or not specific enough to treat the real problem, and some people should not do Kegel exercises. If you have pelvic pain, exercising might be making the pain worse. Seeing a physical therapist who specializes in the pelvis may be the answer to your Kegel questions.

How do I know if I am doing them correctly? How many should I do? What position should I be in? Are you supposed to do them when you pee or when you are at a red light-which is it? Will it help with my urinary leakage? What about with my sex life?

These are common questions I hear in my practice as a pelvic floor physical therapist. I specialize in treating the muscular dysfunctions of the pelvic floor. A group of over 20 separate muscles that lie underneath the pelvic organs (the bladder and the bowels, the uterus and vagina in women, and the prostate in men), the pelvic floor acts to support the organs and gives us voluntary bowel and bladder control. Most people think their bowel, bladder, or genital troubles are due to problems in the organs themselves. Your bladder problem may really be a muscle problem.

The most frequent question I hear is, “What on earth can a physical therapist, of all people, do about my bladder or bowel problem or my pelvic pain?” A lot, actually.

The American Urological Association recently recommended pelvic floor physical therapy as an early treatment option for pelvic floor dysfunction, especially in those with pelvic pain. The pelvic floor muscles are skeletal muscles, which mean they are under your voluntary command. They are controlled by your thoughts, just like the muscles in your arms and legs, which means they can have the same type of problems as any other muscle. Weakness, poor endurance, poor coordination, and even painful tender points and scar tissue adhesions can occur in the pelvic floor muscles. Instead of causing difficulty with walking or lifting, pelvic floor muscle dysfunction can cause incontinence, pelvic organ prolapse, and even pain with intercourse.

So, what does a pelvic PT know?

Pelvic PT’s know that most bladder problems are really muscle problems. Like pinching a garden hose, the pelvic floor muscles contract around the urethra (your bladder tube) to give us bladder control. When you have the urge to urinate and “hold it”, your pelvic floor muscles are doing the holding.

If your pelvic floor muscles don’t have adequate strength, they can’t pinch the urethra tight enough to hold urine inside the bladder. If you have poor endurance in your pelvic floor, you might have trouble making it to the bathroom on time. If you have poor coordination, your pelvic floor muscles might not squeeze fast enough to counteract that cough or sneeze. The same can be said for bowel control, too.

Your average Kegel program is too simple to address these muscle complexities. Bladder and bowel control is dependent on the pelvic floor muscles working in harmony, not just being “strong”.

Think about it-does it make sense that just doing biceps curls would fix every arm problem? No, it doesn’t. Kegels can’t fix every pelvic problem, either. There are many types of pelvic exercises. Kegels are just one type of exercise a pelvic physical therapist might prescribe.

Pelvic PT’s understand pelvic pain.To put it simply, pain inhibits normal muscle function. When we hurt, we don’t move normally. It is easy to see if someone has pain in their knee or ankle – they limp! The pelvic floor is an inside muscle, which makes seeing its dysfunction more difficult.

If your pelvic floor muscles are painful due to an episiotomy scar or other birth trauma, repetitiously contracting the muscles may make your pain worse. You may need exercises that stretch rather than strengthen your pelvic floor. Only a trained pelvic floor physical therapist can evaluate your pelvic muscle function and then prescribe the right type of pelvic floor exercise program for you.

Pelvic PT’s know how to individualize an exercise program. A Physical Therapist uses movement to treat the body the same way a doctor uses medicine. Exercises are prescribed and are individualized to the patient. A triathlete or cross-fitter should, and will, have a different program compared to someone who has never really exercised. Your “movement medicine” is designed to fit your life and the demands your lifestyle puts on your body.

The pelvic floor is not an isolated muscle group. It is anatomically connected to your hips and is a part of your inner core of muscles. Knowing how connected the pelvic floor is to the spine and legs, it is no surprise that back pain and balance troubles are linked with incontinence. In a recent study, 52% of people with low back pain also reported having some form of pelvic floor dysfunction (voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation). Over 80% of those with pain said their pelvic floor symptoms began about the same time as their low back or pelvic pain did.

If you have pelvic pain, back pain, tailbone pain, or genital pain, it is very likely your pelvic floor is part of the problem. Seeing a pelvic floor physical therapist who can tailor a program for you can be a part of your solution.

Pelvic PT’s know a lot about Kegel exercises. A short history lessonThere was a Dr. Kegel. He was a Mayo-trained surgeon who became interested in finding non-surgical treatment options for incontinence in post-partum women in the 1930’s. He did not “invent” the exercises. Therapists in England had been teaching pelvic and pelvic floor exercises since the late 1800’s to new mothers in the maternity wards. He was, however, the first to apply the scientific method to prove pelvic exercises actually worked to reduce urinary incontinence. After decades of research on the best methods on how to teach the exercises, he published his results in 1948. His approach was 84% effective in curing incontinence symptoms. So what happened? The methods Dr. Kegel developed in the lab just didn’t translate well into modern medical practice Unfortunately, in today’s post-partum healthcare world, Dr. Kegel’s methods of teaching pelvic exercises have been replaced with a brochure that new moms are handed as they leave the OB/GYN’s office. Most well-meaning doctors didn’t have the time or resources to duplicate Dr. Kegel’s methods in their clinics. Over the years, the verbal or written description of how to “squeeze down there” started to replace the individualized approach Dr. Kegel was able to take in his research. Dr. Kegel advocated that without one-on-one instruction physical instruction by a trained practitioner, most women would not be able identify the right muscle, therefore making the exercises ineffective. Decades after this assertion was published, multiple studies now support Dr. Kegel’s early observations. One study found that in women who were given only verbal and written instructions on Kegel exercises in an OB/GYN’s office, less than half could demonstrate a correct pelvic floor contraction.How would Dr. Kegel teach you how to do Kegel exercises? First, he would look at and palpate your pelvic floor to make sure you were using the right muscle group. He would then use an internal vaginal pressure sensor called a perineometer, an early type of biofeedback, allowing you to “see” your internal pelvic floor muscles working. He would progress your exercises as you became stronger. You would be instructed several times over the course of weeks or even months.If you have tried Kegels on your own and not gotten the results you wanted, maybe you need a “Kegel coach” – a pelvic physical therapist who has the time (our appointment are an hour long), the equipment (we use modernized biofeedback methods), and the knowledge (it’s our specialty) to evaluate your Kegel skills and then develop an exercise plan especially for you.***Dr. Heather S. Rader, PT, DPT, PRPC, BCB-PMD is a pelvic physical therapist at Sher Pelvic Health and Healing. She holds certifications in pelvic rehabilitation and biofeedback for pelvic muscle dysfunction. She has been a pelvic specialist for over 15 years and is a pelvic floor rehab educator.

Did you know that the abdominal muscles play an integral role in pelvic health? This is an introductory post about the abdominal muscle anatomy. In future posts, we will highlight how this relates to conditions such as diastasis recti, abdominal pain, pelvic pain, hernias, hip dysfunction and much more.

Abdominal Anatomy Facts

The transversus abdominis is the deepest of the abdominal muscles (under the obliques and rectus abdominis) and is a very important "core muscle."

All of the abdominal muscles have an attachment point at (or into a tendinous expansion of) the linea alba - connective tissue raphe formed between the rectus abdominis where the decussating tendinous fibers of the lateral abdominal wall aponeuroses. The linea alba is the region where we see conditions such as diastasis recti.

It is very difficult to isolate abdominal muscles when exercising. Muscles function synergistically. When exercise specialists state "focus on the rectus abdominus," for example, there are movements that will improve that muscle's activation, but other muscles will fire as well. We often cue patients to activate transversus abdominus and minimize rectus or oblique firing. We cannot totally avoid synergistic muscle activation, but we can facilitate activating certain muscles more effectively.

The term "core" is often times synonymous with abdominal muscles. The true "core" is made up of the pelvic floor muscles, transversus abdominis, the diaphragm, and multifidi low back muscles.